Device and method for tissue removal

ABSTRACT

Exemplary embodiments are directed to devices and methods for tissue removal. Exemplary embodiments can be configured for mechanical dissection as well as suction to grasp, resect and collect all or part of a target tissue. Exemplary embodiments may also comprise elements for cauterization of tissue and coagulation of blood vessels.

CROSS-REFERENCE TO RELATED APPLICATION

This application claims priority to U.S. Provisional Patent ApplicationSer. No. 61/624,223 filed Apr. 13, 2012, the entire contents of whichare incorporated herein by reference.

STATEMENT REGARDING FEDERALLY FUNDED RESEARCH

This invention was made with government support under 5K25CA116291awarded by the National Institutes of Health and HRD#0932339 awarded byNational Science Foundation. The government has certain rights in theinvention.

BACKGROUND INFORMATION

Cancer spreading or metastasis is a severe condition that a surgeonwould strive to control in order to save patients' lives. The cancercells often travel through vascular or lymphatic systems to remotesites, which can induce secondary tumors. Excision of lymphatic tissueis an important component of many surgical operations. Termed “lymphnode dissection”, this procedure provides prognostic value for patientsand in some cases may prevent subsequent cancer metastasis. Theconventional lymph node dissection involves surgical removal oflymphatic nodes and vessels near the primary tumors and in the regionallymphatic tissue that provides lymphatic drainage for the primary tumor.

The human body transports fluids and cells in the lymphatic and vascularsystems to maintain normal and healthy functions. Cancer cells caninfiltrate the lymphatic system and spread from an original tumor to aremote site. Once disseminated, eradication of cancer is usually notpossible. Although chemotherapy may help slow the growth of cancer inmetastatic disease, relapse and progression is common and death isinevitable in most solid tumors. In many solid tumors, the tumor isremoved along with the surrounding lymphatic channels. This is done todetermine if the cancer has penetrated the lymphatic system and in somecases it can eradicate the cancer within the lymphatic system. Termedlymph node dissection, these procedures are performed for many types ofcancer including breast, prostate, stomach, uterine, cervical, urinarybladder, testicular, and others.

The commonly used technique for removing the lymphatic tissue is timeconsuming It requires intricate cutting and cauterizing using varioussurgical tools to grasp, resect, or collect the tissue. The tissue mustbe precisely cut to avoid damage to the surrounding arteries, veins, andnerve bundles. During the procedures the patient is anesthetized forprolonged period of times, which may put the patient at a higher riskfor the adverse events and complications. Thus, there is an importantneed for more efficient techniques and devices for removing tissues,such as lymphatic tissue.

SUMMARY

Exemplary embodiments of the present disclosure include a tissue removaldevice comprising: an elongated housing comprising a proximal end and adistal end; an electric motor; a fixed cauterizing element proximal tothe distal end of the housing; and a rotating cauterizing elementproximal to the distal end of the housing, where the electric motor iscoupled to the rotating cauterizing element. In specific embodiments,the elongated housing may be generally cylindrical or close tocylindrical, and in certain embodiments the electric motor may becoupled to the rotating cauterizing element via a drive extension withinthe elongated housing.

Particular embodiments may comprise a drive member coupled to theelectric motor and the drive extension. In certain embodiments, thefixed cauterizing element may comprise a fixed cutting element that iselectrically conductive; the rotating cauterizing element may comprise arotating cutting element that is electrically conductive; and the fixedcutting element may be in contact with the rotating cutting element. Inspecific embodiments, the tissue removal device may be configured sothat an electric power source can be electrically coupled to the fixedcauterizing element. In particular embodiments, the fixed cuttingelement can be electrically coupled to the electric power source via awire extending along a primary length of the elongated housing.

In certain embodiments, the tissue removal device may be configured sothat radio frequency electric power is provided to the fixed cuttingelement. Particular embodiments may comprise a first control switchconfigured to supply electrical power to the fixed cutting element at afirst power level sufficient to cauterize tissue. Specific embodimentscan further comprise a second control switch configured to supplyelectrical power to the fixed cutting element at a second power levelsufficient to coagulate blood vessels. In certain embodiments the wiremay be located in a channel in the elongated housing.

In particular embodiments, the rotating cauterizing element may comprisea rotating cutting element holder that is not electrically conductiveand the fixed cauterizing element may comprise a fixed cutting elementholder that is not electrically conductive. In specific embodiments, thefixed cutting element may extend to an outer circumference of the fixedcutting element holder.

In certain embodiments, the elongated housing may comprise an opening atthe distal end and the rotating cauterizing element may be configured torotate from a first position to a second position, where the firstposition does not cover the opening at the distal end and where thesecond position covers the opening at the distal end. Particularembodiments may also comprise a vacuum source configured to create avacuum within the housing.

Specific embodiments may include a method of removing tissue, where themethod comprises: placing a tissue removal device proximal to a sectionof tissue; inserting the section of tissue into the distal end of theelongated housing; and moving the rotating cauterizing element from afirst position to a second position to remove the section of tissue froma target site. In particular embodiments, the tissue removal device maycomprise: an elongated housing comprising a proximal end and a distalend; an electric motor; a fixed cauterizing element proximal to thedistal end of the housing; and a rotating cauterizing element proximalto the distal end of the housing, wherein the electric motor is coupledto the rotating cauterizing element.

Certain embodiments may also comprise supplying electric power to thefixed cauterizing element. Specific embodiments may also comprisetransmitting electric power from the fixed cauterizing element to therotating cauterizing element. In certain embodiments, the electric powermay be sufficient to cauterize tissue at the target site. In particularembodiments, the electric power may be sufficient to coagulate bloodvessels at the target site. In specific embodiments, inserting thesection of tissue into the distal end of the elongated housing comprisesapplying a vacuum device to the housing to draw the section of tissueinto the housing. In particular embodiments, the tissue may compriselymphatic tissue. In certain embodiments, the tissue may comprise fattissue.

Embodiments of the invention are directed to devices and methods thatimprove the surgical efficiency and shorten the operation time fortissue removal. To serve this purpose, a tissue removal device isdesigned using both mechanical dissection and suction to grasp, resectand collect all or part of a target tissue. In exemplary embodiments,heating elements can be included for tissue removal and/or cauterizationto stop bleeding, as explained in further detail below. The devicedescribed herein can be used in a wide range of tissue removal surgeriesincluding both open and laparoscopic surgery. Also, the device iscapable of removing other kinds of tissues such as fat and skin tissues,in addition to lymphatic tissues. Use of the device described hereinrenders the tissue removal methods significantly faster than theconventional methods of surgery. The device is configured for use inboth open and laproscopic surgery, and the shortened surgery times willsubsequently reduce the time for patients under anesthesia and make itpossible for the surgeon to work with ease and efficiency usingminimally invasive techniques.

In the following, the term “coupled” is defined as connected, althoughnot necessarily directly, and not necessarily mechanically.

In certain aspects, the surgery is carried out in the affected tissuesin which contact between the other body parts and the target need to beminimized The current device is designed in a way to minimize bleedingand inadvertent damage with adjacent viable tissue.

Certain embodiments are directed to a device for resecting a targettissue comprising: (a) a mechanical cutting head having an exterior faceand an interior face, (i) the cutting head comprising at least two fixedblades, the fixed blades forming flow channels in the cutting head; and(ii) one or more movable blades positioned interior to the fixed bladesof the cutting head; and (b) a mounting head coupled to and fluidicallyconnected to the cutting head, the mounting head being configured toprovide a suction force to draw the target tissue inside the cuttinghead where the target tissue is cut by the moveable blades and fixedblades during use.

The device can further comprising heating elements positioned on or inthe fixed blades. In certain aspects, the heating elements are capableof cauterizing tissue.

In certain aspects, the cutting head is 1, 2, 3, 4, 5, 6, 7, 8, 9, or 10mm to 8, 9, 10, 11, 12, 13, 14, or 15 mm, including all values andranges there between, in diameter or at its maximum width. In a furtheraspect, the cutting head can be 1, 2, 3, 4, 5, 6, 7, 8, 9, or 10 cm to8, 9, 10, 11, 12, 13, 14, or 15 cm, including all values and rangesthere between, in diameter or at its maximum width. In a particularaspect, the cutting head is 3 mm to 10 mm in diameter or at its maximumwidth. In certain aspects, the cutting head is 10 mm in diameter or atits maximum width.

In certain aspects, the device comprises 1, 2, 3, 4, 5, 6, 7, 8, 9, 10or more fixed blades. In a further aspect, the device comprises 4 fixedblades. In a further aspect, the device has at least the same number ofmoveable as it does fixed blades. In a further aspect, the device has 2,3, 4, 5, 6, 7, 8, 9, 10, 11, or more moveable blades. In certainaspects, the device has at least 4 moveable blades.

In certain aspects, the fixed blades have an angle of between 55 and 60degrees relative to the long axis of the device. In a further aspect,the fixed blades have an angle of between 57 and 58 degrees relative tothe long axis of the device. In still a further aspect, the fixed bladeshave an angle of about 57.5 or 57.47 degrees relative to the long axisof the device.

Certain embodiments are directed to an apparatus for resecting a targettissue comprising a device of claim 1 operatively coupled to a vacuumsource and a collection container.

Further embodiments are directed to a fixed blade assembly having anoptimized flow velocity through the assembly comprising four or morefixed blades having an angle of 55 to 60 degrees relative to the shortaxis of the assembly. In certain aspects, the blade angle is between 57and 58 degrees relative to the short axis of the assembly. In furtheraspects, the blade angle is or is about 57.47 degrees relative to theshort axis of the assembly. In still a further aspect, the assembly has1, 2, 3, 4, 5, 6, 7, 8, 9, 10 or more fixed blades. In certain aspects,the assembly has a maximum width of 3, 4, 5, 6, 7, 8, 9, or 10 mm. In afurther aspect, the assembly has a maximum width of 1, 2, 3, 4, 5, 6, 7,8, 9, or 10 cm

Certain embodiments are directed to methods of resecting a target tissuecomprising inserting a device as described herein in to a patient inneed of target tissue removal and contacting the target tissue with thedevice, wherein the target tissue is grasped by the device, drawn insidethe device, cut from the patient, and collected. In certain aspects, thetarget tissue is lymphatic, fat, or skin tissue. In certain aspects, thedevice is inserted by open or laparoscopic surgery.

Other embodiments of the invention are discussed throughout thisapplication. Any embodiment discussed with respect to one aspect of theinvention applies to other aspects of the invention as well and viceversa. Each embodiment described herein is understood to be embodimentsof the invention that are applicable to all aspects of the invention

The use of the word “a” or “an” when used in conjunction with the term“comprising” in the claims and/or the specification may mean “one,” butit is also consistent with the meaning of “one or more” or “at leastone.” The term “about” means, in general, the stated value plus or minus5%. The use of the term “or” in the claims is used to mean “and/or”unless explicitly indicated to refer to alternatives only or thealternative are mutually exclusive, although the disclosure supports adefinition that refers to only alternatives and “and/or.”

The terms “comprise” (and any form of comprise, such as “comprises” and“comprising”), “have” (and any form of have, such as “has” and“having”), “include” (and any form of include, such as “includes” and“including”) and “contain” (and any form of contain, such as “contains”and “containing”) are open-ended linking verbs. As a result, a method ordevice that “comprises,” “has,” “includes” or “contains” one or moresteps or elements, possesses those one or more steps or elements, but isnot limited to possessing only those one or more elements. Likewise, astep of a method or an element of a device that “comprises,” “has,”“includes” or “contains” one or more features, possesses those one ormore features, but is not limited to possessing only those one or morefeatures. Furthermore, a device or structure that is configured in acertain way is configured in at least that way, but may also beconfigured in ways that are not listed.

Other objects, features and advantages of the present invention willbecome apparent from the following detailed description. It should beunderstood, however, that the detailed description and the specificexamples, while indicating specific embodiments of the invention, aregiven by way of illustration only, since various changes andmodifications within the spirit and scope of the invention will beapparent to those skilled in the art from this detailed description.

BRIEF DESCRIPTION OF THE DRAWINGS

The following drawings form part of the present specification and areincluded to further demonstrate certain aspects of the presentdisclosure. The invention may be better understood by reference to oneof these drawings in combination with the detailed description ofspecific embodiments presented herein.

FIG. 1 shows a perspective view according to an exemplary embodiment.

FIG. 2 shows an exploded view of the embodiment of FIG. 1.

FIG. 3 shows a section view of the embodiment of FIG. 1.

FIG. 4 shows a partial perspective view of the embodiment of FIG. 1.

FIG. 5 shows a perspective view of a first component of the embodimentof FIG. 1.

FIG. 6 shows a perspective view of a second component of the embodimentof FIG. 1.

FIG. 7 shows a perspective view of a third component of the embodimentof FIG. 1.

FIG. 8 shows a perspective view of a fourth component of the embodimentof FIG. 1.

FIG. 9 shows a perspective view of the components of FIGS. 5-8 inmultiple positions.

FIG. 10 shows a perspective view of the embodiment of FIG. 1.

FIG. 11 illustrates an external three-dimensional view of one embodimentof a tissue removal device.

FIG. 12 illustrates an external side view of one embodiment of a tissueremoval device.

FIG. 13 illustrates an external top view of one embodiment of a tissueremoval device.

FIG. 14 illustrates an inside view of one embodiment of a tissue removaldevice showing moving blades, inlets, and outlets

FIG. 15 illustrates a cross-sectional side view of a tissue removaldevice.

FIG. 16 illustrates an example of an enclosure of one embodiment of atissue removal device.

FIG. 17 illustrates one example of a moving blade assembly in blademount of a tissue removal device.

FIG. 18 illustrates one example of an actuator mount of a tissue removaldevice.

FIG. 19 illustrates an example of an actuator of a tissue removaldevice.

FIG. 20 illustrates an example of a moving blade mount of a tissueremoval device.

FIG. 21 illustrates an example of a cam of a tissue removal device.

FIG. 22 illustrates an example of a fixed blade assembly of a tissueremoval device.

FIG. 23 illustrates an example of a head cover of a tissue removaldevice.

FIG. 24 illustrates an example of a head mount of a tissue removaldevice.

FIG. 25 illustrates an example of a pneumatic adapter of a tissueremoval device.

FIG. 26 illustrates one example of shape optimization of the fixedblades of a tissue removal device.

FIG. 27 illustrates one example of the fixed blade configuration.

DETAILED DESCRIPTION OF ILLUSTRATIVE EMBODIMENTS

Referring initially to FIGS. 1-10, an exemplary embodiment of a tissueremoval device 200 comprises a housing 210 with a proximal end 212, adistal end 214, and an air inlet 211 with a cover 215. As shown moreclearly in the exploded view of FIG. 2, tissue removal device 200further comprises a motor 220 coupled to a drive extension 230 via adrive disc 231, a coupling mechanism 232, and a drive member 233 that issupported by a bearing 234. In the illustrated embodiment, motor 220 isalso coupled to housing 210 via a mounting plate 222. Electrical powerand control signals (e.g. via a microcontroller) can be supplied viawiring 221 to motor 220 and other components of tissue removal device200 requiring electrical power, e.g. cauterizing elements or vacuumdevices described in further detail below. It is understood that thespecific configuration shown in the figures represents merely oneexemplary embodiment of a tissue removal device according to the presentdisclosure, and that other exemplary embodiments may comprises adifferent configuration or combination of components. In addition, forpurposes of clarity, not all components are labeled with referencenumbers in each view.

As will be explained in further detail below, housing 210 is generallycylindrical in shape and further comprises an inlet 216 near distal end214. Housing 210 also comprises an outlet 213 located near proximal end212. Inlet 216 can allow air and the tissue to be removed to enterhousing 210, while outlet 213 can allow air and the tissue that has beenremoved from a target site to exit housing 210.

Referring now to FIGS. 3-4, a section view and an end perspective viewillustrate the flow of air and/or tissue that can occur duringoperation. As shown in the section view of FIG. 3, housing 210 comprisesa partition 217 that divides the interior volume of housing 210 into twocompartments 218 and 219. During operation, a low pressure or vacuum canbe created in compartment 219 so that air flows into air inlet 211 andthrough compartment 218 to compartment 219. In specific embodiments, avacuum device (e.g. a vacuum pump) can be coupled to outlet 213 ofhousing 210. This low pressure or vacuum within housing 210 can assistin drawing or pulling the tissue to be removed into housing 210 at inlet216. In particular embodiments, a sensor may be placed near distal end214 to determine the position of tissue that is drawn into inlet 216. Incertain embodiments, tissue removal device 200 may comprise a positivepressure device (e.g. an air pump) to push tissue towards distal end 214in the event that it is drawn further than desired into housing 210.When the tissue is placed in the desired location near distal end 214,it can then be excised and/or cauterized as explained in more detailbelow. For example, the tissue to be removed can then be excised by ashearing action created between a fixed cutting element 241 and arotating cutting element 247, as explained further below.

Referring specifically now to FIGS. 4-9, in this embodiment fixedcauterizing element 240 and a rotating cauterizing element 245 arelocated proximal to distal end 214 of housing 210. Fixed cauterizingelement 240 comprises a fixed cutting element 241 that is electricallyconductive in a fixed element holder 242 that is not electricallyconductive. In addition, rotating cauterizing element 245 comprises arotating cutting element 247 that is electrically conductive in arotating element holder 243 that is not electrically conductive. In thisembodiment, fixed cutting element 241 is in contact with rotatingcutting element 247 throughout the rotation of rotating cutting element247.

FIG. 9 illustrates rotating cauterizing element 245 in four differentpositions during rotation. In the first position on the left, opening216 at distal end 214 (shown in FIG. 4) is fully open, while in thesecond and third positions opening 216 is partially closed. In thefourth position shown on the far right, rotating cauterizing element 245has rotated 180 degrees from the initial position and opening 216 wouldbe fully closed. As shown in FIG. 9, rotating cutting element 247 isimmediately adjacent and in contact with fixed cutting element 241 sothat the configuration provides a shearing action between the cuttingelements during rotation.

Referring back now to FIG. 4, rotating cauterizing element 245 androtating cutting element 247 are shown in a position that has rotatedapproximately 90 degrees from the initial position in which opening 216is fully open. As rotating cauterizing element 245 continues rotation,opening 216 will be reduced in size until it is fully closed. Any tissuethat is inserted into opening 216 will therefore be sheared or cut byrotating cutting element 247 and fixed cutting element 241.

As shown in FIG. 10, in this embodiment an electric power source (e.g.an alternating current source, battery pack, or other source) can beelectrically coupled to the fixed cutting element 241 via wiring 221 anda wire 223 that extends in a channel 224 along the primary length ofhousing 210. Wire 223 can be coupled to an extension 248 (shown in FIG.6) of fixed cutting element 241. When assembled, extension 248 extendsthrough a slot 249 (shown in FIG. 5) to an outer circumference 259 offixed element holder 242.

In certain embodiments, tissue removal device 200 can be configured toprovide radio frequency electric power to the fixed cutting element 241.In the embodiment shown, tissue removal device 200 can comprise a firstcontrol switch 251 configured to supply electrical power to the fixedcutting element 241 at a first power level sufficient to cauterizelymphatic tissue. Tissue removal device 200 can further comprise asecond control switch 252 configured to supply electrical power to fixedcutting element 241 at a second power level sufficient to coagulateblood vessels. As previously mentioned fixed cutting element 241 androtating cutting element 247 are in contact with each other and areelectrically conductive. Accordingly, the electrical power supplied tofixed cutting element 241 is also conducted to rotating cutting element247. This configuration allows both fixed cutting element 241 androtating cutting element 247 to cauterize tissue and/or coagulate bloodvessels.

In the embodiment shown, a third control switch 253 can be used tocontrol the level of vacuum applied to compartment 219 in housing 210.It is understood that the location and configuration of control switches251, 252 and 253 are shown for example only, and that other exemplaryembodiments may comprise a different location and configuration. Forexample, in certain embodiments, tissue removal device 200 may comprisean ergonomic handle that incorporates the control switches.

The exemplary embodiment shown and described in FIG. 1-10 can allow auser to remove tissue from a target site with a precise cutting actionthat preserves the removed tissue intact and allows it to be analyzed ata later time. It can also allow a user to accurately control the levelof electrical power applied to the cutting elements, which can be usedfor both cauterization and coagulation. This can provide the user withthe flexibility to perform either cauterization or coagulation with asingle instrument. The features shown and described in this exemplaryembodiment allow a user to perform tissue removal procedures efficientlyand accurately.

Referring now to FIGS. 11-27, another exemplary embodiment of a tissueremoval device is illustrated. Certain embodiments of the device cancomprise multiple systems, including cutting blades, vacuum apparatus,water pump, and alternatively heating elements.

FIG. 11 illustrates one embodiment of an assembled tissue removal device10. The cutting head 90 that contains the cutting blades (fix blades 20and movable blades 30) is positioned at the tip or distal end of thelong axis of the device 10. In certain aspects, the cutting head has adiameter of 3 mm to 10 mm. In certain aspects the diameter of thecutting head is about 10 mm. In a further aspect the cutting head mayhave a diameter of 10 mm to 10 cm. The fixed blades assembly 21, whichincludes fix blades 20, is attached with the head cover 40 and then thecombined structure is placed at the distal end of the enclosure 60relative to the long axis of the device, the opposite end of the devicebeing the proximal end. The device can contain 2, 3, 4, 5, 6 or morefixed blades that are configured to optimize velocity of flow throughflow channels formed in the cutting head, optimizing the grasping orsuction force applied to a target tissue during use of the device. Incertain embodiments, the number of fixed blades can be chosen to bebetween four and the total number of moving blades. Fixed blades 20 facethe opposite direction of the moveable blades 30. Fixed blades 20 allhave the same angle. In certain aspects the angle of the fixed bladefrom the horizontal is 50, 52, 53, 54, 55, or 56 to 57, 58, 59, or 60degrees, including all values and ranges there between. In a furtheraspect, the fixed blade angle is in the range of 57 to 58 degrees. Inparticular aspects the fixed blade angle is 57.46 degrees from thehorizontal (FIG. 27). In certain aspects heating elements areincorporated or attached to the fixed blades. In a further aspect, theheating element(s) configured as cauterizing agent(s). The moving blades30 are mounted in the blade mount 80 (see FIG. 17 and FIG. 20) that isattached to the head mount 50 (FIG. 24). The moving blade assembly 120(FIG. 17, comprising moving blades 30 mounted on moving blade mount 80)is positioned proximal to the fixed blades assembly 21 (FIG. 22) andconfigured to cut target tissue that enters the cutting head through oneor more flow channels (i.e. the space formed by fixed blades in thefixed blade assembly) in the cutting head. The actuator 100 (FIG. 19)attached to the actuator mount 110 (FIG. 18), is positioned proximal tothe moving blade assembly 120 (FIG. 17) such that it can move movableblades 30 using cam 130 (FIG. 21). In certain aspects the moveableblade(s) reciprocate, rotate, or scissor. In certain aspects, the bladesare manufactured from medical grade metals or metal alloys approved byFDA. FIG. 12 illustrates an external side view of tissue removal device10. FIG. 13 illustrates an external top view of tissue removal device10. A tubular member can be connected to the mounting head. The tubularmember can be configured to provide vacuum force to the mounting and/ora path for tissue scraps and/or body fluids.

FIG. 14 provides a partially exploded view of tissue removal device 10.The flow channel(s) formed in the fixed blade assembly 21 arefluidically connected to the head mount 50 (FIG. 14) and a vacuum sourceand/or a fluid source (e.g., water source) through pneumatic adapters 70(FIG. 25). A vacuum pump and water pump can be connected throughseparate pneumatic adapters so that they can act separately and createsuction pressure. Alternatively the vacuum source can be a singlemultiphase pump. In certain aspects, one or more flow regulating valvesand/or stop valves are positioned in the tubing or connection from afluid and/or vacuum source.

When suction is applied the fluid source is turned off and the stopvalve at the fluid adapter is kept close. As a result, suction force isgenerated at the distal tip of the device that functions to draw tissuethrough the flow channels and inside the device. The shape of the fixedblades is optimized for maximizing the flow velocity near the distal tipof the device (FIG. 26). Angles of fixed blades, thickness of each bladeand the distance between blades are chosen, but not limited to thesethree, to be shape and topological parameters that are optimized. Theresulting optimal design is significantly superior in comparison to thestraightforward design using vertical angles with equal spacing. Also,the number of fixed blades greater than four but less than or equal thanthe number of moving blades, which is designed to be more than thenumber of fixed blades. As a target tissue enters the device it is cutby the blades. In certain aspects, a reciprocating moving blade motionis created by an actuator/cam assembly. In a further aspect, heatingelements attached to or incorporated in the fixed blades helps tomitigate blood spatter. The vacuum force also helps to prevent bloodfrom escaping through the distal tip of the device and directs flow to acollection container. Tissue scraps are sucked by the vacuum andcollected. In certain aspects a collection container is incorporate intothe device and is fluidically connected to mount head producing tissuescraps and fluid entering the device. In a further aspect, a collectioncontainer can be positioned externally relative to a patient andfluidically connected via tubes or the like.

In certain aspects the device can be operated in cleaning mode. Thecleaning mode can be used with the device inside or outside the body ofa patient. The cleaning mode is initiated if any scrap accumulates andjams the passage through the moving blades. In certain aspects a flowregulating valve and/or stop valve can be opened for cleaning purposesallowing a fluid to flow. The fluid is then sucked in to the head mount.In certain aspects the cleaning fluid (e.g., air) can be pumped in usinga pressure source (e.g., air blower). The fluid can dislodge or move anyaccumulated tissue scraps from the moving blades and make the devicere-usable. In certain aspects the device is used in a continuous modewhere a number of target tissue sites can be removed without removingand re-inserting the device. In certain aspects the cleaning fluid canalso offer lubrication. In certain aspects, the cleaning fluid can alsobe used as a diluting agent.

All of the apparatus, systems and/or methods disclosed and claimedherein can be made and executed without undue experimentation in lightof the present disclosure. While the devices, systems and methods ofthis invention have been described in terms of particular embodiments,it will be apparent to those of skill in the art that variations may beapplied to the devices, systems and/or methods in the steps or in thesequence of steps of the method described herein without departing fromthe concept, spirit and scope of the invention. All such similarsubstitutes and modifications apparent to those skilled in the art aredeemed to be within the spirit, scope and concept of the invention asdefined by the appended claims.

REFERENCES

The contents of the following references are incorporated by referenceherein:

-   U.S. Patent Publication 2003/0125768-   U.S. Patent Publication 2012/0022323-   U.S. Pat. No. 3,954,102-   U.S. Pat. No. 4,009,711-   U.S. Pat. No. 4,201,202-   U.S. Pat. No. 4,318,396-   U.S. Pat. No. 4,342,308-   U.S. Pat. No. 4,407,278-   U.S. Pat. No. 5,062,416-   U.S. Pat. No. 6,475,137-   U.S. Pat. No. 7,011,624-   U.S. Pat. No. 7,367,938-   U.S. Pat. No. 7,338,437-   U.S. Pat. No. 7,407,481-   U.S. Pat. No. 7,442,165-   U.S. Pat. No. 8,126,558-   U.S. Pat. No. 8,290,594-   U.S. Pat. No. 8,287,444

1-41. (canceled)
 42. A tissue removal device comprising: an elongatedhousing comprising a proximal end and a distal end; an electric motor; afixed cauterizing element proximal to the distal end of the housing; anda rotating cauterizing element proximal to the distal end of thehousing, wherein the electric motor is coupled to the rotatingcauterizing element.
 43. The tissue removal device of claim 42 whereinthe electric motor is coupled to the rotating cauterizing element via adrive extension within the elongated housing.
 44. The tissue removaldevice of claim 43 further comprising a drive member coupling theelectric motor and the drive extension.
 45. The tissue removal device ofclaim 42 wherein: the fixed cauterizing element comprises a fixedcutting element that is electrically conductive; the rotatingcauterizing element comprises a rotating cutting element that iselectrically conductive; and the fixed cutting element is in contactwith the rotating cutting element.
 46. The tissue removal device ofclaim 45 wherein the tissue removal device is configured so that anelectric power source can be electrically coupled to the fixedcauterizing element; and the tissue removal device further comprises afirst control switch configured to supply electrical power to the fixedcutting element at a first power level sufficient to cauterize tissue.47. The tissue removal device of claim 46 comprising: a first controlswitch configured to supply electrical power to the fixed cuttingelement at a first power level sufficient to cauterize tissue; and asecond control switch configured to supply electrical power to the fixedcutting element at a second power level sufficient to coagulate bloodvessels.
 48. The tissue removal device of claim 46 wherein: the rotatingcauterizing element comprises a rotating cutting element holder that isnot electrically conductive and wherein the fixed cauterizing elementcomprises a fixed cutting element holder that is not electricallyconductive. and wherein the fixed cutting element extends to an outercircumference of the fixed cutting element holder.
 49. The tissueremoval device of claim 45 wherein: the elongated housing comprises anopening at the distal end; the rotating cauterizing element isconfigured to rotate from a first position to a second position; thefirst position does not cover the opening at the distal end; and thesecond position covers the opening at the distal end.
 50. The tissueremoval device of claim 42 further comprising a vacuum source configuredto create a vacuum within the housing.
 51. A method of removing tissue,the method comprising: placing a tissue removal device proximal to asection of tissue, wherein the tissue removal device comprises: anelongated housing comprising a proximal end and a distal end; anelectric motor; a fixed cauterizing element proximal to the distal endof the housing; and a rotating cauterizing element proximal to thedistal end of the housing, wherein the electric motor is coupled to therotating cauterizing element; inserting the section of tissue into thedistal end of the elongated housing; and moving the rotating cauterizingelement from a first position to a second position to remove the sectionof tissue from a target site.
 52. The method of claim 51 furthercomprising supplying electric power to the fixed cauterizing element.53. The method of claim 52 further comprising transmitting electricpower from the fixed cauterizing element to the rotating cauterizingelement.
 54. The method of claim 51 wherein inserting the section oftissue into the distal end of the elongated housing comprises applying avacuum device to the housing to draw the section of tissue into thehousing.
 55. A device for resecting a target tissue comprising: (a) amechanical cutting head having an exterior face and an interior face,(i) the cutting head comprising at least two fixed blades, the fixedblades forming flow channels in the cutting head; and (ii) one or moremovable blades positioned interior to the fixed blades of the cuttinghead; and (b) a mounting head coupled to and fluidically connected tothe cutting head, the mounting head being configured to provide asuction force to draw the target tissue inside the cutting head wherethe target tissue is cut by the moveable blades and fixed blades duringuse.
 56. The device of claim 55, further comprising heating elementsposition on or in the fixed blades.
 57. The device of claim 55, whereinthe cutting head is 3 mm to 10 mm in diameter.
 58. The device of claim55, wherein the fixed blades have an angle of between 55 and 60 degreesrelative to the long axis of the device.
 59. The device of claim 55,wherein the fixed blades have an angle of between 57 and 58 degreesrelative to the long axis of the device.
 60. The device of claim 55,wherein the fixed blades have an angle of about 57.5 degrees relative tothe long axis of the device.
 61. An apparatus for resecting a targettissue comprising a device of claim 55 operatively coupled to one ormore of a vacuum source, a fluid source, a pressure source, a heatsource, an electrical source, and/or a collection container.